Objective: The purpose of this study was to assess the risk of neonatal death and morbidity in vertex- nonvertex second twins according to the mode of delivery and birth weight. Study design: Data from a retrospective cohort study that was based on all twin births in the United States (1995- 1997) were used. Results: A total of 15,185 vertex- nonvertex second twins were classified into 3 groups: (1) both twins were delivered by cesarean delivery (37.7% ), (2) both twins were delivered vaginally (46.8% ), and (3) the second twin was delivered by cesarean delivery after vaginal delivery of the first twin (15.5% ). The risk of asphyxia- related neonatal deaths and morbidity was increased in the group in which both twins were delivered vaginally and the group in which both twins were delivered by cesarean delivery. The increase in neonatal death in the group in which both twins were delivered vaginally was stronger in the birth weight of < 1500 g. In contrast, in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally, the increase in neonatal morbidity was greater in the group in which the birth weight was 1500 to 4000 g. Conclusion: The risk of neonatal death and morbidity in second- born twins is higher in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally compared with the group in which both twins were delivered by cesarean delivery.
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